Provider Demographics
NPI:1043653058
Name:MCMILLAN, MARTHA BRITTNEY (MSP, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:BRITTNEY
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242 FORK RETCH CT
Mailing Address - Street 2:
Mailing Address - City:MULLINS
Mailing Address - State:SC
Mailing Address - Zip Code:29574-5959
Mailing Address - Country:US
Mailing Address - Phone:843-430-5632
Mailing Address - Fax:
Practice Address - Street 1:719 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:SC
Practice Address - Zip Code:29571-2517
Practice Address - Country:US
Practice Address - Phone:843-423-1811
Practice Address - Fax:843-423-8328
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5129235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist